Healthcare Provider Details

I. General information

NPI: 1376296087
Provider Name (Legal Business Name): RACHEL AKOTH ODILLIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2022
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4501
US

IV. Provider business mailing address

19 TACOMA ST
WORCESTER MA
01605-3516
US

V. Phone/Fax

Practice location:
  • Phone: 706-494-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2359830
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN331108
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: